This instructional course review synthesizes the anatomy, pathology, and treatment of rotator interval lesions. It covers the triangular interval bounded by the coracoid, subscapularis, and supraspinatus and its contents. The authors walk through the spectrum from contracture to laxity to biceps and subscapularis pathology.
Think of the rotator interval as the anterosuperior seal of the glenohumeral joint, not just a triangle of tissue. Its thin capsule maintains negative intra-articular pressure, and the CHL and SGHL resist inferior translation. When you find a sulcus sign that persists in external rotation beyond 45°, suspect interval incompetence and multidirectional instability.
The interval is also where the biceps pulley lives, formed by coalescing subscapularis and CHL fibers. This is why biceps instability and superior subscapularis tears travel together, the so-called hidden lesion.
For surgical decision-making: address the Bankart and capsular laxity first, then evaluate the interval to decide on closure. In biceps pathology, tissue quality and age drive the choice. Recentering a frayed tendon ruptures 25% of the time, so favor tenodesis in older or badly damaged tendons and reconstruction in young throwers.
This instructional course review synthesizes the anatomy, pathology, and treatment of rotator interval lesions. It covers the triangular interval bounded by the coracoid, subscapularis, and supraspinatus and its contents. The authors walk through the spectrum from contracture to laxity to biceps and subscapularis pathology.
Think of the rotator interval as the anterosuperior seal of the glenohumeral joint, not just a triangle of tissue. Its thin capsule maintains negative intra-articular pressure, and the CHL and SGHL resist inferior translation. When you find a sulcus sign that persists in external rotation beyond 45°, suspect interval incompetence and multidirectional instability.
The interval is also where the biceps pulley lives, formed by coalescing subscapularis and CHL fibers. This is why biceps instability and superior subscapularis tears travel together, the so-called hidden lesion.
For surgical decision-making: address the Bankart and capsular laxity first, then evaluate the interval to decide on closure. In biceps pathology, tissue quality and age drive the choice. Recentering a frayed tendon ruptures 25% of the time, so favor tenodesis in older or badly damaged tendons and reconstruction in young throwers.